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Open Versus Minimally Invasive Surgery for Congenital Diaphragmatic Hernia Repair: A Systematic Review and
Emily E Lugard1, Marios Alogakos2, James W F Burns3
1School of Medicine, St George's, University of London, London, UK; Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.
Insights
Minimally invasive surgery (MIS) for congenital diaphragmatic hernia (CDH) shows lower morbidity and mortality but higher recurrence than open surgery (OS). Patient selection for MIS in pediatric CDH needs further research.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes Research
Background:
- Congenital diaphragmatic hernia (CDH) management relies on surgical repair.
- Open surgery (OS) and minimally invasive surgery (MIS) are primary treatment modalities.
Purpose of the Study:
- To compare the safety and efficacy of OS versus MIS for pediatric CDH repair.
Main Methods:
- Systematic review and meta-analysis of 30 studies (6355 patients).
- Searched PubMed, Embase, Cochrane, Web of Science, and Scopus databases.
- Random-effects model used for analysis.
Main Results:
- MIS associated with lower overall morbidity (OR: 0.51), lower mortality (OR: 0.20), and shorter hospital stay (-4.5 days).
- OS associated with lower recurrence rates (OR: 2.09) and shorter operative time (26.8 min).
- Significant heterogeneity observed for operative time and hospital stay.
Conclusions:
- MIS may be considered for pediatric CDH despite higher recurrence rates.
- Optimal patient selection criteria for MIS require further investigation, considering CDH severity and comorbidities.
Introduction:
Surgical repair remains the cornerstone of treatment for congenital diaphragmatic hernia (CDH), with open surgery (OS) and minimally invasive surgery (MIS) as the primary approaches. This study aims to comprehensively evaluate the safety and efficacy of OS versus MIS repairs in the management of pediatric patients with CDH.
Materials And Methods:
PubMed, Embase, Cochrane, Web of Science, and Scopus databases were searched from inception to August 2025. A random-effects model was used for the analysis. The review was registered prospectively with PROSPERO (CRD42024536718).
Results:
Thirty studies meeting the eligibility criteria were included, comprising 6355 patients who underwent OS (n = 5557) or MIS (n = 798). OS was associated with a lower recurrence rate (odds ratio [OR]: 2.09, 95% confidence interval [CI]: 1.49, 2.95, I2 = 0%) and shorter operative time (mean difference: 26.8 min, 95% CI: 8.8, 44.7, I2 = 97%). However, MIS was associated with lower overall morbidity (OR: 0.51, 95% CI: 0.37, 0.72, I2 = 9%), lower mortality (OR: 0.20, 95% CI: 0.11, 0.34, I2 = 0%), and shorter hospital stay (mean difference: -4.5 d, 95% CI: -7.6, -1.3, I2 = 93%) than OS.
Conclusions:
Despite having higher recurrence rates, MIS may be considered in pediatric patients, although optimal patient selection remains undefined. Further studies evaluating stratification based on CDH severity and associated comorbidities are needed to optimize patient selection criteria.
